Biology 103
2003 Second Paper
On Serendip

19 million Americans (approximately one in eight) aged 18-54 suffer from anxiety disorders. (1) When I heard this statistic, I realized how important the discussion of such disorders was to the sciences. 1/8th of the most productive portion of the US population suffers from an anxiety disorder. The National Institute of Mental Health (NIMH), a division of the Institutes of Health for the Federal Government, is committed to research causes and treatment of such disorders. (2) Progress has been made, comparing studies of animals to studies of humans, in pinpointing the specific areas of the brain. Anxiety is associated with fear- fear of a specific object or situation, generalized fear and worry, recurring fearful memories, etc. The NIMH has found that a specific portion of the brain, the amygdala, controls the body's automatic response to fear. When the brain is confronted with fear, the brain takes two course of action. One, the brain transmits information to the cerebral cortex (the thinking part of the brain) to inform it of what specifically is endangering the individual. Second, the brain transmits to the amygdala the same information, so that the body might prepare for action.

Beyond this information, not much is known regarding the causes or mechanics of anxiety. Granted, understanding which portions of the brain are affected by or control anxiety is an important step. However, not much conclusive evidence or useful conclusions have been reached regarding anxiety.

With this information in mind, I began thinking of my personal experiences with anxiety. On one occasion I went to the emergency room, expressing the inability to breathe and dizziness. It was concluded that I was suffering from an anxiety attack, and was offered Xanax. I refused the medicine until I might better research what I would be taking. Much later, I attended counseling in effort to deal with anxiety issues, and once again was offered anti-anxiety medicines, otherwise known as anxiolytics.

Clearly, regardless of the inconclusive evidence regarding the causes of anxiety, the medical professions are quick to administer medicines when faced with a patient suffering from anxiety. My personal encounters with this are not the only evidence. At Bryn Mawr, through counseling services, I know many students who have received anxiolytics. Of course, there is an evaluation process. Nonetheless, many students are able to receive medication, regardless of the inconclusive evidence of the causes of anxiety. Additionally, the statistic regarding one in every eight adults suffers from anxiety proves true amongst my peers, and in fact, is a significantly greater number. Of my fifteen closest friends, both at school and from home, nine have suffered anxiety attacks, two have received medication for anxiety, and two for depression.

I have several concerns with this issue. Many medicines given to treat anxiety have a plethora of negative side effects, everything from insomnia to addiction. While information is available regarding the possible long-term effects of anxiolytics, evidence of their direct connection or effect on anxiety is not available. The question at hand, then, is whether or not it is useful- or even safe- to administer medicines for a disorder of which there is little information or understanding.
To better understand this question, information regarding anti-anxiety drugs is needed. It should be noted that frequently medication is accompanied by psychotherapy. There are many varieties of anti-anxiety medications, but they are all of two types: benzodiazepines and antidepressants. Because there are so many variations of the two, I shall only discuss in detail the two separate types.

Benzodiazepines, which include medicines such as Xanax, Versed, and Restoril, depress the central nervous system (CNS) at the limbic system, which controls automatic functions, the reticular formation of the brain stem, which controls respiration, heart rate, posture, and state of consciousness, and the cortex, which is where most of the brain's neurons are located. (3) These areas of the brain are associated with the function of fear, and the brain's response to fear. A benzodiazepine interferes with this process; however I cannot find information on how. Because it is not clear exactly what happens in the brain to produce anxiety in an individual, understanding how a medicine might interact with the process is impossible.

Benzodiazepines are used to treat many disorders or illnesses besides anxiety. This list includes insomnia, catatonia, alcohol withdrawal symptoms, convulsions, depression, mania, bipolar affective disorder, and PMS. Considering this list, I find the use of such drugs to be very interesting. For one, a benzodiazepine is used to treat insomnia, the inability to sleep, as well as catatonia, which may manifest itself in the inability to respond to stimulus, i.e. a lack of motivation. These are two seemingly opposite illnesses. Additionally, the drug is used to treat PMS, which, though potentially extreme, is a much milder illness than mania. If these drugs can treat such a wide variety of illnesses or disorders, what does this say about the nature of the drug? How can a drug treat two opposing disorders?

Besides these questions, one must consider the adverse affects of benzodiazepines. The most common side affect is generalized sedative effects, such as drowsiness, fatigue, confusion, dizziness, etc. Benzodiazepines may also cause paradoxical agitation, such as insomnia, hallucinations, nightmares, euphoria, rage, etc. Additionally, most benzodiazepines are highly habit forming, as well as tolerance building. Thus, intake of the drug not only must increase over time, which may result in toxic level doses, but also discontinuing use of the drug would result in withdrawal.

Just as with benzodiazepines, there are many variations of antidepressants. For the purposes of this paper, I shall only discuss Selective Serotonin Reuptake Inhibitors (SSRI's), which includes medicines such as Paxil and Prozac. The exact way in which SSRI's work is unknown. However, it has been concluded that they cause a "down-regulation" of receptors by blocking the re-uptake of serotonin. (4) Antidepressants are used primarily for generalized anxiety disorder, which is a general feeling of worry or anxiety, and posttraumatic stress syndrome, which is reoccurring anxiety at the recollections of a specific traumatic memory. Possible side effects of SSRI's include insomnia, chronic fatigue syndrome, mania, and headache, et al. However, most informational websites state that side effects cannot be anticipated for most patients. (5)

This information produces several interesting discussions. It is important, in this discussion, to bear in mind that the health of the patient is the top priority. That having been said, I would like to consider whether it is good for the patient to use drugs such as benzodiazepines and antidepressants for the treatment of anxiety. For one, the causes of anxiety are unknown. Second, the exact mechanisms of these medications are unknown. Putting these two statements together, doctors are using a drug that they do not understand to treat an illness of which there is no clear conclusive evidence. Granted, patients who use these drugs do more often than not experience alleviation of anxiety symptoms. However, the exact way in which their anxiety is being relieved is unknown. How responsible is this of the scientific community?

An additional cause to be weary of these medications is their side effects. They can in fact induce symptoms that they are trying to treat. For a patient suffering from anxiety, occurrences of mania are very dangerous. This is a big risk to take, in my opinion, in hopes that a medicine in some way alleviates an illness that no one has figured out.

There are, of course, benefits of this method of treatment. Once researchers figure out the ways in which antidepressants and benzodiazepines interact with the brain, they can use this knowledge to decipher the way anxiety interacts within the brain, assuming the medications directly treat anxiety. It is a process of elimination of sorts- it is one step in the scientific process of discovery. Thus, perhaps the prescribing of such medications will facilitate researchers. However, I think the scientific community ought to bear in mind the potential dangers of this method before applicating its results directly to patients.

References

1) National Institute of Mental Health

2) National Institute of Mental Health

3) Neuropsychology and medical psychology medical resources

4) Neuropsychology and medical psychology medical resources

5) PDR Health

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